3D打印技术在女性盆腔器官脱垂中的临床应用  

Application of 3D printing technology in female pelvic organ prolapse

作　　者：王志芳 马燕[1] 王卓 桑娜 李索菲 史越越 何瑶 孔敏 杨欣 李妍[2] WANG Zhifang;MA Yan;WANG Zhuo;SANG Na;LI Suofei;SHI Yueyue;HE Yao;KONG Min;YANG Xin;LI Yan(Ningxia Medical University,Yinchuan 750004,China;Department of Gynecology,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学,宁夏银川750004 [2]宁夏医科大学总医院妇科,宁夏银川750004

出　　处：《宁夏医学杂志》2025年第3期222-226,F0003,共6页Ningxia Medical Journal

基　　金：国家自然科学基金项目(82060275);宁夏重点研发计划一般项目(2022BEG03617)。

摘　　要：目的构建基于磁共振成像(MRI)的盆腔器官脱垂(POP)3D打印模型,运用3D打印模型对中盆腔缺陷患者的骶韧带(USL)形态及骶骨段锚定点进行量化及精准定位,提高宫骶韧带高位悬吊术(HUS)的精准性。方法选取术前有3D打印模型指导进行HUS手术的患者(10例)为脱垂组,术前无3D打印模型指导进行HUS手术的患者(10例)作为对照组,选取体检健康成年女性(10例)作为健康组;在静息状态及Valsava动作下行薄层MRI扫描,E3D系统导入MRI编辑、手动分割并构建3D打印模型,精准量化USL长度、USL之间角度,运用3D打印模型对POP患者术前、术后进行精准测量,明确USL锚定点位,分析模型的临床应用。结果10例POP患者中USL起自第一骶骨(S_(1))有3例、第二骶骨(S_(2))有2例、第三骶骨(S_(3))有2例、尾骨肌/骶棘韧带复合体有3例;10例健康组中USL起自S_(1)有3例、S_(2)有2例、S_(3)有1例、第四骶骨(S_(4))有1例、尾骨肌/骶棘韧带复合体有3例。10例术前有3D打印模型指导的POP患者,根据3D打印模型及临床查体盆腔器官脱垂定量(POP-Q)标准恢复正常者有10例,手术治愈率100%,10例复查正常者MRI及3D打印模型可见右侧USL结构改变。10例术前无3D打印模型指导的POP患者,根据3D打印模型及临床查体POP-Q标准恢复正常者有9例,1例复发,为Ⅰ期,手术治愈率90%,9例复查正常者MRI及3D打印模型可见右侧USL结构改变,1例复发患者右侧USL结构与未复发患者有明显差异。结论3D打印模型能够精准定位USL的锚定点,提高HUS的精准度,有效降低复发率。Objective To construct a 3D printed model of pelvic organ prolapse(POP)based on magnetic resonance imaging(MRI),and to use the 3D printed model to quantify and accurately locate the morphology of the subsacral ligament(USL)and the anchor points of the sacral segment in patients with mid-pelvic defects,and to guide the accuracy of high uterosacral ligament suspension(HUS).Methods Ten patients who underwent HUS surgery with preoperative 3D printing model guidance were selected as the prolapse group,10 patients who underwent HUS surgery without preoperative 3D printing model guidance were selected as the control group,and 10 healthy adult women who underwent physical examination were selected as the healthy group;Resting state and Valsava maneuver descending thin layer MRI scan,the E3D system imports MRI editing,manual segmentation and builds a 3D printing model to accurately quantify the length of the USL and the angle between the USLs.The 3D printing model is used to accurately measure POP patients before and after surgery to clarify the USL anchor point.Clinical applications of analytical models.Results Among the 10 POP patients,USL originated from the first sacrum(S_(1))in three cases,the second sacrum(S_(2))in two cases,the third sacrum(S_(3))in two cases,and the coccygeal muscle/sacrospinous ligament complex in three cases;among the 10 healthy controls,USL originated from S_(1) in three cases,S_(2) in two cases,S_(3) in one case,the fourth sacrum(S_(4))in one case,and the coccygeal muscle/sacrospinous ligament complex in three cases.Among the 10 POP patients who had 3D printed models for guidance before surgery,10 cases recovered to normal according to the 3D printed models and clinical examination POP-Q standards,with a surgical cure rate of 100%.MRI and 3D printed models showed changes in the right USL structure in the 10 patients who were normal after reexamination.Ten POP patients without 3D printing model guidance before surgery,9 cases recovered according to the 3D printing model and clinical examination

关 键 词：磁共振成像 3D打印技术 盆腔器官脱垂 

分 类 号：R711[医药卫生—妇产科学]